Insurance Update: Appeal Denied

I had hoped to post on Friday since the girl from BCBS promised to call me.  I should have known it wasn't good news when I didn't get a call and she was out of office every time I called.  Such cowards!!!

So they denied me again because they still contend that my BMI is not over 50, and thus saying thatthe DS for me is not medically necessary.  Well, I don't know about you boys and girls, but my math says that any way you stack 290.8 pounds on a 5'3" frame gives you a BMI of 51.5.  They are choosing to look at old numbers that were wrong when the doc submitted them back in May.  The doc's office put 5'4" but I am and have been 5'3" for over a year now (not only MO but have yet another ruptured disc in my lower back) and have paperwork to back that up from my PCP. 

So tomorrow I call my patient advocate and we go from there.  Grievance hearing is next.   I don't care if I have to strip naked and step on a scale in front of the whole damn room full of folks doing the hearing.  I WILL!!!  I'll bet the sight of my fat ass standing in front of them naked would be enough to convince them to grant me approval!!!

And Annie, if you read this, I'm NOT GIVING UP, Girl!!!  You're my inspiration!!!!

Angela
Best of luck to you, I just love the insurance office making decisions about peoples lives that they really know nothing about.. I hope you win your next appeal with them!! and LMAO at stripping down nude... I hear ya!!! best of luck!!

Darcie

Thanks Darcie!  I see you doing so well and I hope one day to have my ticker all the way over to the right like yours.  You look great!

How's your tooth feeling these days?  I saw your posts about the pain you were in and I hope it's on the mend now.

I appreciate your good wishes, and I hope we can meet in person sometime soon at at meetup!

I'll bring the buttered popcorn!

Give them hell!

Angela,

I hope that you will get a hearing soon so that you can move forward soon.

Hang in there my friend,

Barb

Catch me up....is it the choice of surgery that they are denying? You do fit the criteria for the RNY. I wonder when the insurance companies will begin following doctor's advice for what we need done instead of a bunch of words on paper......

Hey Ann,

It probably is the type of surgery they are denying since they stated in the denial letter that I was most welcome to have the RNY.  Thing is, not only do I fit the criteria for RNY, but I also fit the criteria for the DS!  That's what makes me SO stinkin' mad!!  I DO have a BMI over 50, so I qualify for the DS.  It's discrimination at it's finest!  I need and want to have the DS for a myriad of personal and physical reasons, and I refuse to have a surgery that I know will not benefit me in the long run (think: NSAIDS due to arthritis and other joint issues).

Like you, I wonder when they will heed doctor's advice for what's best for a patient.  Probably never since they are strictly in the business of making money - they could really care less about the health of people.

Hope you're doing well!

I second Andrea's post...give 'em hell!!!  Heck, grab a bunch of us in all stages of WLS and we'll all march in there nekkid with you.  Pre-op, post-op, pre-PS, post-PS.  I'll bet they would be scrambling to sign on the dotted line then. 

I love how you've done your research to KNOW what will be your best fit in regards to WLS.  How can they not see that??? 

Hey Shauna,

Yes, wouldn't that be TOO darn funny if we all marched in and got nekkid?  I really appreciate your willingness to show that solidarity. 

Thanks for your encouragement, too.  You know, I used to ask myself why they wouldn't approve me because it will save them a ton of money in the long run.  But I've learned that they are only concerned about the profit they can make in the current quarter, and that's it.  Which I suppose makes sense given that I could change jobs or my company could change insurance companies, so their investment now wouldn't necessarily mean savings for them later.  And all that I can somewhat swallow and tolerate reasonably well.  But the thing that really gets me is that BCBS is a NOT FOR PROFIT organization, and yet, they turn a hefty profit.  My personal opinion is that they should be forced to give all the profit back to the members!!  Darn it!

Ok, off my soapbox now.  Thanks again, and I hope to meet you soon at a monthly meetup!

Unfortunately, I had to delete this message due to privacy concerns.